A Study on Safety and Efficacy of Zigzag Skin Incision in General Surgery Among Elective Cases of Acute Appendicitis, Inguinal Hernia and Soft Tissue Tumour - Randomized Controlled Trial

Background: Straight line, the conventional incision technique, is against the principle of plastic surgery when it is not along the minimal line of tension on body. This incisional technique is widely practiced by general surgeons whilst zigzag incision if used, would be advantageous as it facilitates in enhanced exposure to surgical field and aesthetically better scar. In this study zigzag incisional technique was evaluated in terms of safety and efficacy in elective surgery cases of acute appendicitis, inguinal hernia and soft tissue tumour. Methods: Stratified randomization done for the patients included in cases of general surgery like acute appendicitis, inguinal hernia and soft tissue tumor. These patients were divided in the two groups, conventional incision group and zigzag incision group. Exposure to the surgical field was recorded as qualitative- bad, good and excellent according to operating surgeon. Scar assessment was done after 1 week, 1 month and 6 months. Results: Upon comparison of result, it was observed with zigzag incision, the exposure to surgical field was better than conventional straight-line technique. Additionally, the surgical scar was aesthetically better compared to the straight incision used in general surgery cases like appendectomy, inguinal hernia repair, soft tissue tumor excision but there was no significant difference in case of hernia and appendicitis cases. Conclusion: Zigzag incision can be used safely in place of traditional incision in the elective general surgery cases of acute appendicitis, inguinal hernia and soft tissue tumour. Zigzag incision provides better exposure of surgical field although this is subjective measure of surgeon’s experience, shows statistically significant difference. Zigzag incision heals better than straight line and gives aesthetically better scar, it can be used in cases such as open appendectomy, open inguinal hernia repair and excision of soft tissue swelling. Keywords: Zigzag incision, Straight incision, aesthetic scar, exposure of surgical field.